Staging and Treatment Update for Gynecologic Malignancies
|
|
- Audra Barton
- 5 years ago
- Views:
Transcription
1 Staging and Treatment Update for Gynecologic Malignancies Bunja Rungruang, MD Medical College of Georgia No disclosures 4 th most common new cases of cancer in women 5 th and 6 th leading cancer deaths in women Seigel RL, et al. CA Cancer J Clin 2018;68:
2 Access to Care by Gynecologic Oncologists Number of Gynecologic oncologists per Hospital Referral Region (HRR) 9 15% of women live in areas with limited access 7,663 women with GYN cancers annually live in the low access GRAY areas Shalowitz, David I. et al. Gynecol Oncol 2015;138: Cancer Cases in GA and SC Estimated New Cancer Cases All Cases Breast Uterine Cervix Georgia 56,920 7,490 1, South Carolina 30,450 4, Estimated Cancer Deaths All sites Breast Lung Ovary Georgia 17,730 1,320 4, South Carolina 10, , Seigel RL, et al. CA Cancer J Clin 2018;68:7-30. Estimated New Cases Vagina Uterine Cervix Vulva Ovary Seigel RL, et al. CA Cancer J Clin 2018;68:
3 FIGO Staging Primer *Not the TNM system used for all other cancers Stage I: Confined to the primary organ Ex: Ovary, uterus, cervix Stage II: Local spread Ex: Fallopian tube, cervix, parametria Stage III: Regional spread Ex: Omentum, pelvic lymph nodes, sidewall Stage IV: Distant spread Ex: Liver, omentum, rectum 3
4 Ovarian Cancer Stage I: Organ Stage II: Local Stage III: Regional Stage IV: Distant Stage I: Tumor confined to ovary IA: Limited to one ovary, negative ascites, no tumor on surface, capsule intact IB: Limited to both ovaries, negative ascites, no tumor on surface, capsule intact IC: Either stage IA or IB but with tumor on surface or capsule ruptured or positive washings IC1: Surgical spill IC2: Capsule rupture or tumor on surface of ovary or tube IC3: Malignant ascites or peritoneal washings Stage II: Local spread IIA: Tumor involves uterus or tubes IIB: Extension to other pelvic tissues Stage III: Regional spread IIIA1: Positive retroperitoneal nodes (RPN) only IIIA1(i): Retroperitoneal nodal metastases <10 mm IIIA2(ii): Retroperitoneal nodal metastases >10 mm FIGO Ovarian Cancer Staging Effective Jan 1, 2014 IIIA2: Microscopic peritoneal metastasis beyond pelvis, + retroperitoneal nodes (RPN) IIIB: Abdominal implants grossly present and <2cm in diameter, + RPN IIIC: Abdominal implants >2cm in diameter, + RPN Stage IV: Distant metastasis IVA: Pleural effusion with positive cytology IVB: Liver or spleen parenchymal metastasis; Lymph nodes outside of abdominal cavity Prat J,, et al. Int J Gynecol Obstet 2014; 124:1-5. Mahajan A, et al. Semin Ultrasound CT MRI 2017; 38:
5 SURGERY CHEMOTHERAPY 5
6 Ovarian Cancer Therapy Surgery + Chemotherapy REMISSION Recurrence Therapy Maintenance Therapy RECURRENCE Uterine Cancer Carcinoma (Endometrium) Endometrioid Clear Cell Carcinosarcoma Sarcoma (Myometrium) Leiomyosarcoma Endometrial Stromal Sarcoma Adenosarcoma Endometrial Cancer Staging Stage I: Organ Stage II: Local Stage III: Regional Stage IV: Distant 6
7 Endometrial Cancer Staging Effective May 2009 Stage I: Tumor confined to corpus uteri IA: No or <50% myometrial invasion IB: Invasion to >50% of myometrium *Endocervical gland involvement only should be considered as Stage I. Stage II: Local spread II: Tumor invades cervical stroma but does not extend beyond the uterus Stage III: Regional spread IIIA: Tumor invades uterine serosa and/or adnexa *Positive cytology has to be reported separately without changing the stage IIIB: Vaginal and/or parametrial involvement IIIC: Metastasis to pelvic or paraaortic lymph nodes IIIC1: positive pelvic lymph nodes IIIC2: positive paraaortic lymph nodes with or without positive pelvic lymph nodes Stage IV: Distant metastases IVA: Tumor invasion of bladder and/or bowel mucosa IVB: Distant metastasis including intra-abdominal or inguinal lymph node metastasis Pecorelli S,, et al. Int J Gynecol Obstet 2009; 105: Endometrial Cancer TNM Staging Stage IA Endometrial Cancer Stage IB Endometrial Cancer Stage II Endometrial Cancer FIGO Stage Histologic Grade Adjuvant Treatment IA G1, G2 Observation preferred OR Vaginal brachytherapy if any high risk factors* G3 Vaginal brachytherapy preferred OR Consider observation if no risk factors* IB G1, G2 Vaginal brachytherapy preferred OR Consider observation if no risk factors* G3 Radiation (vaginal brachytherapy and/or whole pelvic) + systemic chemotherapy II G1, G2 Radiation (vaginal brachytherapy and/or whole pelvic) G3 Whole pelvic radiation therapy + vaginal brachytherapy + systemic chemotherapy *Risk factors include age, depth of myometrial invasion, and lymphovascular invasion 7
8 Advanced Endometrial Treatment Stage III: Regional Stage IV: Distant Stage IIIA Endometrial Cancer Stage IIIB Endometrial Cancer Stage IIIC Endometrial Cancer Stage IVA Endometrial Cancer Stage IVB Endometrial Cancer Whole pelvic radiation +Systemic therapy Systemic therapy +Whole pelvic radiation Uterine Cancer Carcinoma (Endometrium) Endometrioid Clear Cell Carcinosarcoma Sarcoma (Myometrium) Leiomyosarcoma Endometrial Stromal Sarcoma Adenosarcoma Endometrial stromal sarcoma (ESS) and Adenosarcoma Stage I: Tumor limited to uterus IA: Limited to endometrium with no myometrial invasion IB: < 50% myometrial invasion IC: > 50% myometrial invasion Stage II: Local spread (pelvis) IIA: Adnexal involvement IIB: Extends to extrauterine pelvis Stage III: Regional spread (abdomen) IIIA: One site IIIB: > One site IIIC: Pelvic and/or para-aortic nodes Stage IV: Distant metastasis IVA: Invades bladder and/or rectum IVB: Distant metastasis Uterine Leiomyosarcoma Effective May 2009 Stage I: Tumor limited to uterus IA: < 5cm IB: > 5cm Stage II: Local spread (pelvis) IIA: Adnexal involvement IIB: Extends to extrauterine pelvis Stage III: Regional spread (abdomen) IIIA: One site IIIB: > One site IIIC: Pelvic and/or para-aortic nodes Stage IV: Distant metastasis IVA: Invades bladder and/or rectum IVB: Distant metastasis Pecorelli S,, et al. Int J Gynecol Obstet 2009; 105:
9 Uterine Sarcoma Treatment Endometrial stromal sarcoma (ESS) and Adenosarcoma Uterine Leiomyosarcoma and Undifferentiated Sarcoma Low Grade Stage I: Observation or Hormonal therapy Low Grade II-IV: Hormonal therapy High Grade: Systemic therapy + Radiation Therapy Stage I: Observation or Systemic chemotherapy Stage II-IV: Systemic chemotherapy Stage I Cervical Cancer Treatment Stage I: Tumor confined to cervix CAN YOU SEE IT? Stage IA1/IA2 Cervical Cancer IA: Microscopic invasion, with deepest invasion <5mm and largest extension <7mm IA1: Stromal invasion of <3mm in depth and extension of <7mm Cone or Simple Hysterectomy IA2: Stromal invasion of >3mm and <5mm with extension of <7mm Radical Hysterectomy + PLND IB: Clinically visible lesions limited to cervix or pre clinical cancer greater than stage IA IB1: Clinically visible lesion <4cm in greatest dimension Radical Hysterectomy + PLND IB2: Clinically visible lesion >4cm in greatest dimension Radical Hysterectomy + PLND OR Chemoradiation Stage IB1 Cervical Cancer Stage IB2 Cervical Cancer 9
10 Simple vs. Radical Hysterectomy Stage II Cervical Cancer Treatment Stage II: Tumor invades beyond the uterus, but not to pelvic wall or to the lower 1/3 of the vagina CAN YOU FEEL IT ON EXAM BUT STILL GET AROUND IT? IIA: Without parametrial invasion (i.e upper vagina only) IIA1: Clinically visible lesion <4cm in greatest dimension Radical Hysterectomy + PLND IIA2: Clinically visible lesion >4cm in greatest dimension Radical Hysterectomy + PLND IIB: With parametrial invasion Chemoradiation Stage III Cervical Cancer Treatment Stage III: Tumor extends to the pelvic wall and/or involves lower 1/3 of vagina and/or causes hydronephrosis or non functioning kidney ALL YOU FEEL IS CANCER ON EXAM OR +CT Stage IIIA Cervical Cancer IIIA: Tumor involves lower 1/3 of vagina, with no extension to the pelvic wall IIIB: Extension to the pelvic wall and/or hydronephrosis or non functioning kidney Stage IIIB Cervical Cancer Chemoradiation 10
11 Cervical Cancer: Stage IV Stage IV: Tumor extends beyond the true pelvis or has involved bladder or rectal mucosa Chemotherapy + Radiation therapy IVA: Spread to adjacent organs IVB: Spread to distant organs Stage IVA Cervical Cancer Stage IVB Cervical Cancer Stage I: Tumor confined to cervix IA: Microscopic invasion, with deepest invasion <5mm and largest extension <7mm IA1: Stromal invasion of <3mm in depth and extension of <7mm IA2: Stromal invasion of >3mm and <5mm with extension of <7mm IB: Clinically visible lesions limited to cervix or pre-clinical cancer greater than stage IA IB1: Clinically visible lesion <4cm in greatest dimension IB2: Clinically visible lesion >4cm in greatest dimension Stage II: Tumor invades beyond uterus, but not to pelvic wall or to lower 1/3 of vagina IIA: Without parametrial invasion IIA1: Clinically visible lesion <4cm in greatest dimension IIA2: Clinically visible lesion >4cm in greatest dimension IIB: With parametrial invasion Stage III: Tumor extends to the pelvic wall and/or involves lower 1/3 of vagina and/or causes hydronephrosis or non-functioning kidney IIIA: Tumor involves lower 1/3 of vagina, with no extension to the pelvic wall IIIB: Extension to the pelvic wall and/or hydronephrosis or non-functioning kidney Stage IV: Tumor extends beyond the true pelvis or has involved bladder or rectal mucosa IVA: Spread to adjacent organs IVB: Spread to distant organs Cervical Cancer Staging Effective May 2009 Pecorelli S, et al. Int J Gynecol Obstet 2009; 105: New FIGO staging for Cervical Cancer coming in 2019! New Updates for Cervical Cancer Published in NEJM on October 31, 2018 Shift back to open radical abdominal hysterectomies 11
12 Other HPV-related Cancers Vaginal Cancer FIGO Stage (Staging effective May 2009) Stage I Invasive carcinoma confined to vagina Stage IA Tumor <2 cm wide and <1 mm depth of invasion Stage IB Tumor > 2cm wide and >1 mm depth of invasion Stage II Local spread to paravaginal tissues Stage III Regional spread to the pelvic sidewall Stage IV Distant disease Stage IVA Stage IVB Extension beyond true pelvis or invasion of bladder/rectum Pelvic or inguinal lymphadenopathy or distant metastases Treatment: Chemoradiation Pecorelli S, et al. Int J Gynecol Obstet 2009; 105: Vulvar Cancer Stage I: Tumor confined to vulva with negative nodes IA: Lesion <2cm in size, confined to vulva or perineum and with stromal invasion of <1mm IB: Lesion >2cm in size or with stromal invasion of >1mm, confined to the vulva or perineum Stage II: Local spread Stage II: Tumor of any size with extension to adjacent perineal structures (1/3 lower urethra, 1/3 lower vagina, and/or extension to anus) with negative nodes Stage III: Tumor of any size with or without extension to the adjacent perineal structures (1/3 lower urethra, 1/3 lower vagina, anus) with positive inguino-femoral lymph nodes IIIA1: 1 lymph node metastasis >5mm IIIA2: 1-2 lymph node metastasis(es) of <5mm IIIB1: 2 or more lymph node metastases >5mm IIIB2: 3 or more lymph node metastases <5mm IIIC: Positive node(s) with extracapsular spread Stage IV: Other regional (2/3 upper urethra, 2/3 upper vagina) or distant metastases IVA1: Upper urethral and/or vaginal mucosa, bladder mucosa, rectal mucosa, or fixation to bony pelvic structures IVA2: Fixed or ulcerated inguino-femoral lymph nodes Effective May 2009 IVB: Distant metastasis including pelvic lymph nodes Pecorelli S, et al. Int J Gynecol Obstet 2009; 105:
13 Vulvar Cancer Stage IA <2cm size, <1mm depth Stage IB Any size, >1mm depth Stage II Simple vulvectomy Radical vulvectomy + Inguinal LND Radical vulvectomy + Inguinal LND + Radiation 4 th most common new cases of cancer in women 5 th and 6 th leading cancer deaths in women Seigel RL, et al. CA Cancer J Clin 2018;68:7-30. SOLO 1 New Advances 13
14 What s Next??? Sentinel lymph node mapping for endometrial and cervical cancers 14
The International Federation of Gynecology and Obstetrics (FIGO) updated the staging
Continuing Education Column Revised FIGO Staging System Hee Sug Ryu, MD Department of Obstetrics and Gynecology, Ajou University School of Medicine E - mail : hsryu@ajou.ac.kr J Korean Med Assoc 2010;
More informationType I. Type II. Excess estrogen Lynch Endometrioid adenocarcinoma PTEN. High grade More aggressive Serous, Clear Cell p53
Type I Excess estrogen Lynch Endometrioid adenocarcinoma PTEN Type II High grade More aggressive Serous, Clear Cell p53 Stage I IA IB Stage II Stage III IIIA IIIB IIIC IIIC1 IIIC2 Stage IV IVA IVB nodes
More informationNew Cancer Cases By Site Breast 28% Lung 14% Colo-Rectal 10% Uterus 6% Thyroid 5% Lymphoma 4% Ovary 3%
Uterine Malignancy New Cancer Cases By Site 2010 Breast 28% Lung 14% Colo-Rectal 10% Uterus 6% Thyroid 5% Lymphoma 4% Ovary 3% Cancer Deaths By Site 2010 Lung 26% Breast 15% Colo-Rectal 9% Pancreas 7%
More informationProposed All Wales Vulval Cancer Guidelines. Dr Amanda Tristram
Proposed All Wales Vulval Cancer Guidelines Dr Amanda Tristram Previous FIGO staging FIGO Stage Features TNM Ia Lesion confined to vulva with
More informationC ORPUS UTERI C ARCINOMA STAGING FORM (Carcinosarcomas should be staged as carcinomas)
CLINICAL C ORPUS UTERI C ARCINOMA STAGING FORM PATHOLOGIC Extent of disease before S TAGE C ATEGORY D EFINITIONS Extent of disease through any treatment completion of definitive surgery y clinical staging
More informationCervical Cancer: 2018 FIGO Staging
Cervical Cancer: 2018 FIGO Staging Jonathan S. Berek, MD, MMS Laurie Kraus Lacob Professor Stanford University School of Medicine Director, Stanford Women s Cancer Center Senior Scientific Advisor, Stanford
More informationStaging. Carcinoma confined to the corpus. Carcinoma confined to the endometrium. Less than ½ myometrial invasion. Greater than ½ myometrial invasion
5 th of June 2009 Background Most common gynaecological carcinoma in developed countries Most cases are post-menopausal Increasing incidence in certain age groups Increasing death rates in the USA 5-year
More information2009 USCAP Gyn Pathology Evening Session Case #3. Richard J. Zaino, MD Hershey Medical Center Penn State University Hershey, PA
2009 USCAP Gyn Pathology Evening Session Case #3 Richard J. Zaino, MD Hershey Medical Center Penn State University Hershey, PA rzaino@psu.edu Clinical history Middle aged woman with an exophytic mass of
More informationNorth of Scotland Cancer Network Clinical Management Guideline for Carcinoma of the Uterine Cervix
THIS DOCUMENT North of Scotland Cancer Network Carcinoma of the Uterine Cervix UNCONTROLLED WHEN PRINTED DOCUMENT CONTROL Prepared by A Kennedy/AG Macdonald/Others Approved by NOT APPROVED Issue date April
More informationC ORPUS UTERI C ARCINOMA STAGING FORM (Carcinosarcomas should be staged as carcinomas)
C ORPUS UTERI C ARCINOMA STAGING FORM CLINICAL Extent of disease before any treatment y clinical staging completed after neoadjuvant therapy but before subsequent surgery Tis * T1 I T1a IA NX N0 N1 N2
More informationUterus Malignancies /5/15
Collecting Cancer Data: Uterus 2014-2015 NAACCR Webinar Series February 5, 2015 Q&A Please submit all questions concerning webinar content through the Q&A panel. Reminder: If you have participants watching
More informationEndometrial Cancer. Incidence. Types 3/25/2019
Endometrial Cancer J. Anthony Rakowski DO, FACOOG MSU SCS Board Review Coarse Incidence 53,630 new cases yearly 8,590 deaths yearly 4 th most common malignancy in women worldwide Most common GYN malignancy
More informationGynecologic Oncologist. Surgery Chemotherapy Radiation Therapy Hormonal Therapy Immunotherapy. Cervical cancer
Gynecologic Oncology Pre invasive vulvar, vaginal, & cervical disease Vulvar Cervical Endometrial Uterine Sarcoma Fallopian Tube Ovarian GTD Gynecologic Oncologist Surgery Chemotherapy Radiation Therapy
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER CERVIX
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER CERVIX Site Group: Gynecology Cervix Author: Dr. Stephane Laframboise 1. INTRODUCTION 3 2. PREVENTION 3 3. SCREENING AND
More informationWhat is endometrial cancer?
Uterine cancer What is endometrial cancer? Endometrial cancer is the growth of abnormal cells in the lining of the uterus. The lining is called the endometrium. Endometrial cancer usually occurs in women
More informationNorth of Scotland Cancer Network Clinical Management Guideline for Endometrial Cancer
THIS DOCUMENT North of Scotland Cancer Network Clinical Management Guideline for Endometrial Cancer Based on WOSCAN CMG with further extensive consultation within NOSCAN UNCONTROLLED WHEN PRINTED DOCUMENT
More informationPRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER VULVAR
PRINCESS MARGARET CANCER CENTRE CLINICAL PRACTICE GUIDELINES GYNECOLOGIC CANCER VULVAR Last Revision Date July 2015 1 Site Group: Gynecologic Cancer Vulvar Author: Dr. Stephane Laframboise 1. INTRODUCTION
More informationNAACCR Webinar Series /7/17
COLLECTING CANCER DATA: UTERUS 2017 2018 NAACCR WEBINAR SERIES Q&A Please submit all questions concerning webinar content through the Q&A panel. Reminder: If you have participants watching this webinar
More informationUterine Cervix. Protocol applies to all invasive carcinomas of the cervix.
Uterine Cervix Protocol applies to all invasive carcinomas of the cervix. Protocol revision date: January 2005 Based on AJCC/UICC TNM, 6 th edition and FIGO 2001 Annual Report Procedures Cytology (No Accompanying
More informationJanjira Petsuksiri, M.D
GYN malignancies Janjira Petsuksiri, M.D Outlines Cervical cancer Endometrial cancer Ovarian cancer Vaginal cancer Vulva cancer 2 CA Cervix Epidemiology - Second most common female cancer Risk factors
More informationNew FIGO Staging of Uterine malignancies with MR Imaging: Correlation with Surgical and Histopathologic Findings
New FIGO Staging of Uterine malignancies with MR Imaging: Correlation with Surgical and Histopathologic Findings Poster No.: C-1548 Congress: ECR 2011 Type: Educational Exhibit Authors: J. Takahama, A.
More informationUTERINE SARCOMA EXAMPLE OF A UTERINE SARCOMA USING PROPOSED TEMPLATE
UTERINE SARCOMA EXAMPLE OF A UTERINE SARCOMA USING PROPOSED TEMPLATE Case: Adenosarcoma with heterologous elements and stromal overgrowth o TAH, BSO, omentectomy, staging biopsies of cul-de-sac, bladder
More informationMPH Quiz. 1. How many primaries are present based on this pathology report? 2. What rule is this based on?
MPH Quiz Case 1 Surgical Pathology from hysterectomy performed July 11, 2007 Final Diagnosis: Uterus, resection: Endometrioid adenocarcinoma, Grade 1 involving most of endometrium, myometrial invasion
More informationCurrent staging of endometrial carcinoma with MR imaging
Current staging of endometrial carcinoma with MR imaging Poster No.: C-1436 Congress: ECR 2015 Type: Educational Exhibit Authors: M. Magalhaes, H. Donato, C. B. Marques, P. Gomes, F. Caseiro Alves; Coimbra/PT
More informationUterine Malignancies. Collecting Cancer Data: Uterine Malignancies 10/7/2010. NAACCR Webinar Series 1. Questions. Fabulous Prizes!!!
Uterine October 7, 2010 NAACCR 2010-2011 Webinar Series Session 1 1 Questions Please use the Q&A panel to submit your questions Send questions to All Panelist 2 Fabulous Prizes!!! 3 NAACCR 2010-2011 Webinar
More informationGuideline for the Management of Vulval Cancer
Version History Guideline for the Management of Vulval Cancer Version Date Brief Summary of Change Issued 2.0 20.02.08 Endorsed by the Governance Committee 2.1 19.11.10 Circulated at NSSG meeting 2.2 13.04.11
More informationSTUMPed for a Diagnosis Contemporary Management of Uterine Sarcomas
UCSF Helen Diller Family Comprehensive Cancer Center Disclosures I have no financial disclosures STUMPed for a Diagnosis Contemporary Management of Uterine Sarcomas Lee-may Chen, MD Department of Obstetrics,
More informationAdjuvant Therapies in Endometrial Cancer. Emma Hudson
Adjuvant Therapies in Endometrial Cancer Emma Hudson Endometrial Cancer Most common gynaecological cancer Incidence increasing in Western world 1-2% cancer deaths 75% patients postmenopausal 97% epithelial
More informationARROCase: Locally Advanced Endometrial Cancer
ARROCase: Locally Advanced Endometrial Cancer Charles Vu, MD (PGY-3) Faculty Advisor: Peter Y. Chen, MD, FACR Beaumont Health (Royal Oak, MI) November 2016 Case 62yo female with a 3yr history of vaginal
More informationCervical cancer presentation
Carcinoma of the cervix: Carcinoma of the cervix is the second commonest cancer among women worldwide, with only breast cancer occurring more commonly. Worldwide, cervical cancer accounts for about 500,000
More information3/25/2019. Rare uterine cancers ~3% Leiomyosarcoma Carcinosarcoma (MMMT) Endometrial Stromal Sarcomas Aggressive tumors High Mortality Rates
J. Anthony Rakowski D.O., F.A.C.O.O.G. MSU SCS Board Review Coarse Rare uterine cancers ~3% Leiomyosarcoma Carcinosarcoma (MMMT) Endometrial Stromal Sarcomas Aggressive tumors High Mortality Rates Signs
More informationreceive adjuvant chemotherapy
Women with high h risk early stage endometrial cancer should receive adjuvant chemotherapy Michael Friedlander The Prince of Wales Cancer Centre and Royal Hospital for Women The Prince of Wales Cancer
More informationCPC on Cervical Pathology
CPC on Cervical Pathology Dr. W.K. Ng Senior Medical Officer Department of Clinical Pathology Pamela Youde Nethersole Eastern Hospital Cervical Smear: High Grade SIL (CIN III) Cervical Smear: High Grade
More informationARRO Case: Early-stage Endometrial Cancer
ARRO Case: Early-stage Endometrial Cancer Ankit Modh, MD (PGY-4) Faculty Advisor: Mohamed A Elshaikh, MD Department of Radiation Oncology Henry Ford Cancer Institute Case Presentation 70 y/o African American
More informationMRI in Cervix and Endometrial Cancer
28th Congress of the Hungarian Society of Radiologists RCR Session Budapest June 2016 MRI in Cervix and Endometrial Cancer DrSarah Swift St James s University Hospital Leeds, UK Objectives Cervix and endometrial
More informationChapter 2: Initial treatment for endometrial cancer (including histologic variant type)
Chapter 2: Initial treatment for endometrial cancer (including histologic variant type) CQ01 Which surgical techniques for hysterectomy are recommended for patients considered to be stage I preoperatively?
More informationCervical Cancer 3/25/2019. Abnormal vaginal bleeding
Cervical Cancer Abnormal vaginal bleeding Postcoital, intermenstrual or postmenopausal Vaginal discharge Pelvic pain or pressure Asymptomatic In most patients who are not sexually active due to symptoms
More informationNorth of Scotland Cancer Network Clinical Management Guideline for Cancer of the Ovary
North of Scotland Cancer Network Cancer of the Ovary Based on WOSCAN CMG with further extensive consultation within NOSCAN UNCONTROLLED WHEN PRINTED DOCUMENT CONTROL Prepared by NOSCAN Gynaecology Cancer
More informationReferral and Management Guidelines for Gynaecological Cancers within North Trent
North Trent Cancer Network Referral and Management Guidelines for Gynaecological Cancers within North Trent Final Version 3.0 August 2011 Review date : June 2013 Produced by the North Trent Cancer Network
More informationGynaecology NSSG (Lancs & South Cumbria) Uterine Cancer Guidelines (V4.0)
Gynaecology NSSG (Lancs & South Cumbria) Uterine Cancer Guidelines (V4.0) ** VALID ON DATE OF PRINTING ONLY all guidelines available on the Strategic Clinical Network website : GMLSC SCN Date first published
More informationGynecologic Oncology Overview Staging updates and Soap Box Issues
Gynecologic Oncology Overview Staging updates and Soap Box Issues Andrew. Green, M.D. Gynecologic Oncology Northeast Georgia Physician s Group Gainesville, GA 1 Overview 1) Review recent changes to FIGO/TNM
More informationEssex & East Suffolk Gynae Cancer Supra-Network
Essex & East Suffolk Gynae Cancer Supra-Network Gynaecological Cancers Referral, Diagnosis and Management Guidelines Constitution Version Number 9.0 Author Members of the NSSG Date Written August 2010
More informationENDOMETRIAL CANCER Updated Apr 2017 by: Dr. Jenny Ko (Medical Oncologist, Abbotsford Cancer Centre)
ENDOMETRIAL CANCER Updated Apr 2017 by: Dr. Jenny Ko (Medical Oncologist, Abbotsford Cancer Centre) Source: UpToDate 2017, ASCO/CCO/Alberta provincial guidelines, NCCN Reviewed by: Dr. Sarah Glaze (Gynecologic
More informationJacqui Morgan March 6, 2019
Jacqui Morgan March 6, 2019 Case 1 25yo, G2P1 Here for WWE, no problems, healthy, needs refill on OCPs. Pap- Abnormal Glandular Cells-NOS Now What?? Case 1 Colposcopy What findings? Case 1 ECC Cervical
More informationAlgorithms for management of Cervical cancer
Algithms f management of Cervical cancer Algithms f management of cervical cancer are based on existing protocols and guidelines within the ESGO comunity and prepared by ESGO Educational Committe as a
More informationThe new FIGO classification in endometrial carcinoma
The new FIGO classification in endometrial carcinoma Poster No.: C-1073 Congress: ECR 2012 Type: Educational Exhibit Authors: A. IGLESIAS CASTAÑON, M. Arias Gonzales, J. Mañas Uxó, 1 2 1 2 2 2 B. NIETO
More informationInvasive Cervical Cancer: Squamous Cell, Adenocarcinoma, Adenosquamous
Note: If available, clinical trials should be considered as preferred treatment options for eligible patients (www.mdanderson.org/gynonctrials). Other co-morbidities are taken into consideration prior
More informationCoversheet for Network Site Specific Group Agreed Documentation
Coversheet for Network Site Specific Group Agreed Documentation This sheet is to accompany all documentation agreed by Pan Birmingham Cancer Network Site Specific Groups. This will assist the Network Governance
More informationPlease complete prior to the webinar. HOSPITAL REGISTRY WEBINAR FEMALE REPRODUCTIVE SYSTEM EXERCISES CASE 1: FEMALE REPRODUCTIVE
Please complete prior to the webinar. HOSPITAL REGISTRY WEBINAR FEMALE REPRODUCTIVE SYSTEM EXERCISES PHYSICAL EXAMINATION CASE 1: FEMALE REPRODUCTIVE 3/5 Patient presents through the emergency room with
More informationGYNAECOLOGICAL CANCER CLINICAL GUIDELINES
Northern England Strategic Clinical Networks GYNAECOLOGICAL CANCER CLINICAL GUIDELINES Gynae-Oncology NSSG on behalf of NECN Document Information Title: NECN Gynae Cancer Clinical Guidelines Author: Gynae
More informationGuidelines for Assigning Summary Stage 2000
Guidelines for Assigning Summary Stage 2000 Mary Lewis, CTR National Program of Cancer Registries 2014 NCRA Annual Meeting May 17, 2014 National Center for Chronic Disease Prevention and Health Promotion
More informationICRT รศ.พญ.เยาวล กษณ ชาญศ ลป
ICRT รศ.พญ.เยาวล กษณ ชาญศ ลป Brachytherapy การร กษาด วยร งส ระยะใกล Insertion การสอดใส แร Implantation การฝ งแร Surface application การวางแร physical benefit of brachytherapy - very high dose of radiation
More informationCARCINOMA CERVIX. Dr. PREETHI REDDY. B. M S OBG II yr POST GRADUATE.
CARCINOMA CERVIX Dr. PREETHI REDDY. B M S OBG II yr POST GRADUATE. Introduction Cervical cancer is the second most common female malignancy worldwide. It is responsible for 4,66,000 deaths annually worldwide
More informationEndometrial Cancer. Saudi Gynecology Oncology Group (SGOG) Gynecological Cancer Treatment Guidelines
Saudi Gynecology Oncology Group (SGOG) Gynecological Cancer Treatment Guidelines Endometrial Cancer Emad R. Sagr, MBBS, FRCSC Consultant Gynecology Oncology Security forces Hospital, Riyadh Epidemiology
More informationVulvar Carcinoma. Definition: Cases should be classified as carsinoma of the vulva when the primary site growth is in the vulva Malignant melanoma sho
Carcinoma Vulva & Vagina Subdivisi Onkologi Ginekologi Bagian Obgin FK USU Vulvar Carcinoma. Definition: Cases should be classified as carsinoma of the vulva when the primary site growth is in the vulva
More informationCarcinoma of the Fallopian Tube
119 Carcinoma of the Fallopian Tube APM HEINTZ, F ODICINO, P MAISONNEUVE, U BELLER, JL BENEDET, WT CREASMAN, HYS NGAN and S PECORELLI STAGING Anatomy Primary site The Fallopian tube extends from the posterior
More informationPORTEC-4. Patient seqnr. Age at inclusion (years) Hospital:
May 2016 Randomisation Checklist Form 1, page 1 of 2 Patient seqnr. Age at inclusion (years) Hospital: Eligible patients should be registered and randomised via the Internet at : https://prod.tenalea.net/fs4/dm/delogin.aspx?refererpath=dehome.aspx
More information3/25/2019. J. Anthony Rakowski D.O., F.A.C.O.O.G. MSU SCS Board Review Coarse
J. Anthony Rakowski D.O., F.A.C.O.O.G. MSU SCS Board Review Coarse 1 4 th most common GYN cancer 5% of malignancies of GYN type. 4850 new cases annually 1030 deaths Cigarette smoking Vulvar dystrophy (Lichen
More informationUICC TNM 8 th Edition Errata
UICC TNM 8 th Edition Errata ions are in italics Head and Neck Tumours Pages 20, p27, p34, p38, p41, and p49 ly pn2a Metastasis in a single ipsilateral lymph node, less than 3cm in greatest dimension with
More informationCase 1. Gynaecology Case Presentation. Objectives. Disclosures 22/10/ year old female Clinical history: Assess right ovarian cyst
Gynaecology Case Presentation Organ Imaging 2016 University of Toronto Sarah Johnson 39 year old female Clinical history: Assess right ovarian cyst Clinically diagnosed endometriosis Started fertility
More informationUTERINE SARCOMAS CURRENT THERAPEUTIC OPTIONS
Review Journal of Translational Medicine and Research, volume 19, no. 1-2, 2014 UTERINE SARCOMAS CURRENT THERAPEUTIC OPTIONS N. Bacalbaæa 1, A. Traistaru 2, I. Bãlescu 3 1 Carol Davila University of Medicine
More informationGynecological Cancers in Primary Care
Gynecological Cancers in Primary Care Nora M. Lersch MSN CRNP AOCNP Division of Gynecological Oncology Objectives Identify the incidence of ovarian, cervical, vulvar and endometrial cancer Identify common
More informationCREOG Review. Gynecologic Oncology
CREOG Review Gynecologic Oncology 2016 American Cancer Society Statistics 2015 New Cases by Site Breast 231,840 Lung 105,590 Colo-Rectal 63,610 Uterus 54,870 Thyroid 47,230 N-H Lymphoma 32,000 Melanoma
More informationSCBT.MR MRI of Uterine Malignancy. Susan M. Ascher, MD, FSCBT.MR Georgetown University School of Medicine Washington, DC
2 0 1 6 SCBT.MR MRI of Uterine Malignancy Susan M. Ascher, MD, FSCBT.MR Georgetown University School of Medicine Washington, DC aschers@gunet.georgetown.edu MUST READS Sala E, et al. The added role of
More informationThis protocol is intended to assist pathologists in providing
Protocol for the Examination of Specimens From Patients With Carcinomas of the Endometrium A Basis for Checklists Steven G. Silverberg, MD, for the Members of the Cancer Committee, College of American
More informationSCAN Gynaecological Group. Clinical Management Protocols vulval cancer
SE Scotland Cancer Network SCAN Gynaecological Group Clinical Management Protocols vulval cancer 2009 www.scan.scot.nhs.uk August 2001 updated annually, most recently INTRODUCTION The South East Scotland
More informationOvarian Cancer Includes Epithelial, Fallopian Tube, Primary Peritoneal Cancer, and Ovarian Germ Cell Tumors
Ovarian Cancer Includes Epithelial, Fallopian Tube, Primary Peritoneal Cancer, and Ovarian Germ Cell Tumors Overview Ovarian epithelial cancer, fallopian tube cancer, and primary peritoneal cancer are
More informationEndometrial Stromal Sarcoma
May 26, 2011 By Sushila Ladumor, MD [1] Endometrial stromal sarcoma (ESS) is a rare malignant tumor of the endometrium, occurring in the age group of 40-50 years. History The 50-year-old, female patient
More informationGYNAECOLOGICAL CANCER CLINICAL GUIDELINES
GYNAECOLOGICAL CANCER CLINICAL GUIDELINES Gynae-Oncology Expert Advisory Group Document Information Title: Cancer Alliance Gynae Cancer Clinical Guidelines Author: Gynae EAG Members Circulation List: See
More informationUICC 8 th Edition Errata 25 th of May 2018
UICC 8 th Edition Errata 25 th of May 2018 ions are in italics Head and Neck Tumours Page 19 Oral Cavity T2 T3 T4a Tumour 2 cm or less in greatest dimension and more than 5 mm but no more than 10 mm depth
More informationPre-operative Evaluation and Implications
Pre-operative Evaluation and Implications Michal Zikan Gynecologic Oncology Center Charles University in Prague, First Faculty of Medicine No recommendation for screening of EC (HNPCC annual biopsies starting
More informationENDOMETRIAL CANCER. Endometrial cancer is a great concern in UPDATE. For personal use only. Copyright Dowden Health Media
For mass reproduction, content licensing and permissions contact Dowden Health Media. UPDATE ENDOMETRIAL CANCER Are lymphadenectomy and external-beam radiotherapy valuable in women who have an endometrial
More informationGENERAL DATA. Sex : female Age : 40 years old Marriage status : married
GENERAL DATA Sex : female Age : 40 years old Marriage status : married CHIEF COMPLAINT Bilateral ovarian tumors discovered by sonography accidentally PRESENT ILLNESS 2003-06-26 :bilateral ovarian tumors
More informationWinship Cancer Institute of Emory University Optimizing First Line Treatment of Advanced Ovarian Cancer
Winship Cancer Institute of Emory University Optimizing First Line Treatment of Advanced Ovarian Cancer Ira R. Horowitz, MD, SM, FACOG, FACS John D. Thompson Professor and Chairman Department of Gynecology
More informationGynecological sarcoma
Gynecological sarcoma Therapy of the gynecological sarcoma Treatment gynecologist s update view Frédéric Amant MD PhD Gynecologic Oncology, KU Leuven, Belgium Center Gynecologic Oncology Amsterdam (CGOA),
More informationCase Scenario 1. Pathology report Specimen from mediastinoscopy Final Diagnosis : Metastatic small cell carcinoma with residual lymphatic tissue
Case Scenario 1 Oncology Consult: Patient is a 51-year-old male with history of T4N3 squamous cell carcinoma of tonsil status post concurrent chemoradiation finished in October two years ago. He was hospitalized
More informationMANAGEMENT OF CERVICAL CANCER
MANAGEMENT OF CERVICAL CANCER Dr. Ujeen Shrestha Malla* and Prof. Dr. Zhang Shui Rong Department of Obstetrics and Gynaecology, Clinical Medical College of Yangtze University, Jingzhou Central Hospital,
More informationL/O/G/O. Ovarian Tumor. Xiaoyu Niu Obstetrics and Gynecology Department Sichuan University West China Second Hospital
L/O/G/O Ovarian Tumor Xiaoyu Niu Obstetrics and Gynecology Department Sichuan University West China Second Hospital Essentials classification of ovarian tumor clinical manifestation of ovarian tumor metastatic
More informationEndometrium. Protocol applies to all carcinomas of the endometrium. Procedures Cytology (No Accompanying Checklist) Biopsy Curettage Hysterectomy
Endometrium Protocol applies to all carcinomas of the endometrium. Protocol revision date: January 2005 Based on AJCC/UICC TNM, 6 th edition and FIGO 2001 Annual Report Procedures Cytology (No Accompanying
More informationUICC TNM 8 th Edition Errata
UICC TNM 8 th Edition Errata ions are in italics Page 28 Oropharynx p16 positive Pathological Stage II,T2 N2 M0 T3 N0,N1 M0 Stage II,T2 N2 M0 T3,T4 N0,N1 M0 Page 61 Oesophagus Adenocarcinoma Pathological
More informationThe Role of Radiation in the Management of Gynecologic Cancers. Scott Glaser, MD
The Role of Radiation in the Management of Gynecologic Cancers Scott Glaser, MD Nothing to disclose DISCLOSURE Outline The role of radiation in: Endometrial Cancer Adjuvant Medically inoperable Cervical
More informationSonographic Detection of Cervical Carcinoma With Metastases
634026JDMXXX10.1177/8756479316634026Journal of Diagnostic Medical SonographyChappell and Fisher research-article2016 Case Study Sonographic Detection of Cervical Carcinoma With Metastases Journal of Diagnostic
More informationNAACCR Webinar Series 1 Q&A. Fabulous Prizes. Collecting Cancer Data: Ovary 11/3/2011. Collecting Cancer Data: Ovary
NAACCR 2011 2012 Webinar Series Collecting Cancer Data: Ovary Q&A Please submit all questions concerning webinar content through the Q&A panel. Reminder: If you have participants watching this webinar
More informationImaging of endometrial and cervical cancer
Insights Imaging (2010) 1:309 328 DOI 10.1007/s13244-010-0042-7 REVIEW Imaging of endometrial and cervical cancer Shilpa Patel & Sidath H. Liyanage & Anju Sahdev & Andrea G. Rockall & Rodney H. Reznek
More informationMost common cancer Africans & Asians more prone because of poor socioeconomic condition Drastic decline in west as more detection of preinvasive
CANCER CERVIX Most common cancer Africans & Asians more prone because of poor socioeconomic condition Drastic decline in west as more detection of preinvasive leison by PAP Smears. Etiology: Age - 2 peaks
More informationVaginal intraepithelial neoplasia
Vaginal intraepithelial neoplasia The terminology and pathology of VAIN are analogous to those of CIN (VAIN I-III). The main difference is that vaginal epithelium does not normally have crypts, so the
More information29 Cancer of the Uterine Corpus
29 Cancer of the Uterine Corpus Robbert Soeters INTRODUCTION Malignancies affecting the uterine corpus are endometrial adenocarcinoma and uterine sarcomas. ENDOMETRIAL ADENOCARCINOMA Endometrial adenocarcinoma
More informationCancer of the corpus uteri
DOI: 10.1002/ijgo.12612 FIGO CANCER REPORT 2018 Cancer of the corpus uteri Frédéric Amant 1,2,3, * Mansoor Raza Mirza 4 Martin Koskas 5 Carien L. Creutzberg 6 1 Division of Gynecologic Oncology, University
More informationENDOMETRIAL CANCER: A GUIDE FOR PATIENTS
ENDOMETRIAL CANCER: A GUIDE FOR PATIENTS PATIENT INFORMATION BASED ON ESMO CLINICAL PRACTICE GUIDELINES This guide for patients has been prepared by Reliable Cancer Therapies (RCT) as a service to patients,
More informationUniversity of Kentucky. Markey Cancer Center
University of Kentucky Markey Cancer Center Invasive Cancer of the Vagina and Urethra Fred Ueland, MD No matter what you accomplish in your life, the size of your funeral will still be determined by the
More informationEndometrial cancer. Cathrine Holland
Endometrial cancer athrine Holland Abstract Endometrial cancers are the most common gynaecological malignancies in the UKwith approximately 4500 new cases occur each year and the incidence is rising. Increasingly
More informationRitu Salani, M.D., M.B.A. Assistant Professor, Dept. of Obstetrics & Gynecology Division of Gynecologic Oncology The Ohio State University
Cervical Cancer Ritu Salani, M.D., M.B.A. Assistant Professor, Dept. of Obstetrics & Gynecology Division of Gynecologic Oncology The Ohio State University Estimated gynecologic cancer cases United States
More informationCase Scenario 1. History
History Case Scenario 1 A 53 year old white female presented to her primary care physician with post-menopausal vaginal bleeding. The patient is not a smoker and does not use alcohol. She has no family
More informationHistorical Perspective
AJCC Cancer Staging 8 th Edition Alexander B. Olawaiye, MD University of Pittsburgh Validating science. Improving patient care. No materials in this presentation maybe repurposed without the Cancer. Permission
More informationH&E, IHC anti- Cytokeratin
Cat No: OVC2281 - Ovary cancer tissue array Lot# Cores Size Cut Format QA/QC OVC228101 228 1.1mm 4um 12X19 H&E, IHC anti- Cytokeratin Recommended applications: For Research use only. RNA or protein ovary
More informationGynecologic Malignancies. Kristen D Starbuck 4/20/18
Gynecologic Malignancies Kristen D Starbuck 4/20/18 Outline Female Cancer Statistics Uterine Cancer Adnexal Cancer Cervical Cancer Vulvar Cancer Uterine Cancer Endometrial Cancer Uterine Sarcoma Endometrial
More informationInteractive Staging Bee
Interactive Staging Bee ROBIN BILLET, MA, CTR GA/SC REGIONAL CONFERENCE NOVEMBER 6, 2018? Clinical Staging includes any information obtained about the extent of cancer obtained before initiation of treatment
More informationof surgical management of early invasive cervical cancer chapter Diagnosis and staging Wertheim described the principles
chapter 14. Surgical management of early invasive cervical cancer CHAPTER 1 Wertheim described the principles of surgical management of invasive cervical cancer more than 100 years ago in his treatise
More informationComputed tomography for evaluation of cervical carcinoma: Our experience in a tertiary care hospital.
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 17, Issue 12 Ver. 2 (December. 2018), PP 10-15 www.iosrjournals.org Computed tomography for evaluation
More information